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Model-Informed Precision Dosing: What Clinicians Need to Know

Megan N. Freeland, PharmD
December 4, 2020

You might’ve heard of precision dosing before. Perhaps it’s popped up in conversations about precision medicine. Or maybe you’ve heard of the InsightRX Nova platform at conferences like Rock Health Summit or IDWeek

But what is model-informed precision dosing, really?

The Food and Drug Administration defines precision dosing as the process of individualizing medication doses by “taking into account patient factors that can modify drug response.” That definition gets at the heart of what precision dosing is and why it matters. 

We’ll dig further into that definition in this article and help you understand:

  • The benefits of precision dosing
  • Which medications could benefit from precision dosing
  • How to find the right dosing software for your institution

What is Model-Informed Precision Dosing?

Model-informed precision dosing (MIPD) uses data from existing patients—in the form of a pharmacokinetic (PK) or pharmacodynamic (PD) model—to predict a patient’s likely response to a given dosing regimen. Then with Bayesian forecasting, that same model can be incorporated into the interpretation of measured levels, creating a patient-specific pharmacological profile to inform how best to adjust dosing for that specific patient.

In academic medicine, pharmacy, and nursing programs, you generally learn appropriate dosing ranges for various drugs. These ranges give you an idea of what dose of medication you might start a patient on, what maintenance dose you may keep them on, or how you might account for liver or kidney dysfunction. But overall, these ranges aren’t specific to an individual patient’s body or condition at any given time.

MIPD takes dosing several steps further. Rather than settling on an acceptable dose estimate, it can be used to home in on the ideal dose for the individual patient. 

Of course, this degree of individualization can only be achieved with the use of dosing software powered to combine the population PK information and the individual patient data to produce a precise dose or dosing regimen. 

Benefits of Model-Informed Precision Dosing

Improves clinical patient outcomes like efficacy and/or safety

According to the World Health Organization (WHO), medication errors globally cost about $42 billion every year. The need to reduce harm during the medication use process is dire. 

Being able to proactively assess a patient’s risk for negative outcomes and prescribe a dose that maximizes efficacy while minimizing that risk is quite valuable. MIPD software is especially relevant and useful when working with medications with a narrow therapeutic index. 

Complements clinical expertise

Another major benefit of MIPD lies in the way it complements the expertise of clinical staff. Rather than replacing clinicians’ expertise, precision dosing enhances it by allowing clinicians to tailor their prescribing regimens to their individual patients and increasing confidence in these regimens.

Medications that Benefit from MIPD

Clinical use of MIPD was recorded as early as 1973 with “computer-assisted” digoxin dosing. Since then, MIPD technology has evolved, becoming even more accessible to healthcare providers and institutions. Across this transformation, MIPD concepts have been applied to a variety of therapies like vancomycin and busulfan.

Vancomycin

Vancomycin is one of the most recent drugs to have officially entered the model-informed precision dosing universe. The newest set of vancomycin dosing and therapeutic monitoring guidelines shifted the official recommendation from first-order pharmacokinetic calculations to AUC-guided vanco dosing with the assistance of Bayesian dosing software

Beyond just vancomycin, clinicians may find benefit in using precision dosing for various antibiotics in critically ill patients.

Busulfan

Busulfan is a chemotherapy agent used to prepare a patient’s bone marrow for a hematopoietic stem cell transplant (HCT). With busulfan, it’s critical to establish the perfect balance between enough busulfan to avoid graft-failure post-transplant, but not so much that the patient is at increased risk for major side effects and toxicity. MIPD can play a major role in achieving this balance.

Options for Model-Informed Precision Dosing Software

At InsightRX, we value precision dosing done right. That’s why we’re proud to have the leading model-informed precision dosing software. We’ve developed a cloud-based clinical decision support solution—InsightRX Nova—that complements clinicians’ expertise and helps them individualize treatment at the point of care.

Learn how our MIPD software—InsightRX Nova—compares to others.

To get a feel for how InsightRX would work for your institution, request a free trial.


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